Fetal Alcohol Spectrum Disorders (FASD), first described in the U.S. in 1973 by Jones and Smith, encompasses a pattern of structural abnormalities, growth deficiency, and neurobehavioral impairment that occurs in the offspring of women who consume moderate to heavy amounts of alcohol in pregnancy. FASD is thought to represent the leading known preventable causes of neurobehavioral impairment in the U.S. and perhaps throughout the world. The proposed study offers the opportunity within the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) consortium of projects to describe the spectrum of alcoholrelated effects, to identify risk factors that are antecedent to pregnancy outcome, to test within-pregnancy interventions, and also to test methods that will allow for earlier identification of alcohol-related birth outcomes. Specifically, the proposed research will utilize a prospective cohort study design involving pregnant women and their offspring recruited in Russia and Ukraine to address major gaps in knowledge about FASD by accomplishing the following specific aims: 1) to more fully delineate the complete range of expression of FASD in relation to specific quantities, patterns and gestational timing of alcohol exposure, and to evaluate the sensitivity of methods for earlier recognition of affected children;2) to assess the contribution of maternal nutritional status in relation to physical and neurobehavioral outcomes associated with prenatal alcohol exposure, and to test the benefit of maternal second and third trimester supplementation with multinutrients with or without choline with respect to risk for FASD in the offspring;and 3) in collaboration with other CIFASD investigators, to provide a well-characterized sample of mothers/children with and without prenatal exposure to alcohol for testing of alternative and earlier methods of identifying affected children, including prenatal ultrasound and post-natal 3D facial imaging. The proposed research has public health relevance from the standpoint of providing an improved estimate of the magnitude and scope of alcoholrelated developmental problems in the context of specific quantities and patterns of prenatal alcohol exposure using standardized methods for assessment, and from the standpoint of developing and validating critically necessary clinical methods for improved and early recognition of affected children and testing the potential benefit of a reasonably applied prenatal intervention that may help ameliorate negative outcomes.